SulAmérica disqualifies oncology center in SP – 06/17/2023 – Health

Retired Hamilton Parise Filho, 63, has been treating a brain tumor since February 2022, when he had a recurrence of the disease. He has already undergone surgery, radiotherapy and is currently undergoing chemotherapy sessions.

Trader Iracema Gianzantti, 59, is also facing a recurrence of cancer, a breast tumor diagnosed at the end of last year. After the mastectomy, it is now treated with chemotherapy. Two more sessions are planned and then radiotherapy and immunotherapy.

Both were surprised at the beginning of the month with the news that the oncology clinic where they are being treated, the CCC (Centro Oncológico de Combate ao Câncer), in São Paulo, would be disqualified by SulAmérica as of this Saturday (17).

“It is a delicate treatment, he is fragile, he has been hospitalized several times to treat lung and kidney problems resulting from the drop in immunity. It doesn’t make any sense to interrupt it now”, says Sarita, Parise Filho’s wife.

Iracema is also indignant and fearful. “We paid almost BRL 12,000 for a health plan [para ela, o marido e dois filhos]. I’ve been a customer since I was 19 and the insurance company didn’t even get in touch with us. I called there, confirmed and they indicated me [outras clínicas]. It’s inhumane, the patients are all desperate.”

In the message sent to patients, the clinic communicates that, after almost 30 years as a referenced oncology center, it was “unilaterally disqualified by SulAmérica”. He informs that, due to this, the treatment would be covered by the plan until June 17th. It also asks patients to contact their operator for more information.

That’s what Parise Filho, Iracema and almost 150 other patients did. In recorded calls to the SAC (Customer Service) of SulAmérica, they claim to maintain the cancer treatment at the clinic until the end of it. The attendants explain that this is not possible and that the insurer has the right to disqualify them.

In recent days, some patients have received phone calls from the operator suggesting other places where they could continue their oncological treatment. “I didn’t accept it. I’m having complications that are still being investigated. How am I going to stop this and start over in an unknown place?”, he questions.

Patients also filed complaints with the ANS (National Supplementary Health Agency) and are now organizing a collective action against the operator.

wanted by SheetSulAmérica declared that “the adjustment in the accreditation for cancer treatments is only valid for new requests and that patients with treatments in progress remain unchanged”.

He also said that “any information to the contrary is wrong”. She also said that the insurer will contact all patients undergoing treatment to clarify possible doubts and reinforce that all care already started will continue at the clinic of origin. “For SulAmérica, the health and well-being of the beneficiary is a priority”, she informed.

Also in a note, the ANS says that non-hospital providers, in this case clinics, offices and laboratories, can only be disqualified if they are replaced by other equivalent ones.

“There is no need for authorization or communication to the ANS, but the operator must notify beneficiaries through its website and the Call Center, 30 days in advance, and keep the information available for consultations for 180 days.”

The ANS also says that it cannot interfere in the contractual relationship between the operator and its providers and that, in the case of ongoing treatments, the beneficiary must choose another provider that offers the same service.

Complaints about the disqualification of service providers by operators have skyrocketed at the agency in recent years.

There were 918 complaints in 2020, 1,917 in 2021 and 3,818 in 2022. In the specific case of SulAmérica, there were 16, 57 and 521 complaints, respectively. Between January and May of this year, a total of 643 complaints were registered, of which 105 referred to SulAmérica.

According to lawyer Rafael Robba, a specialist in the right to health at Vilhena Silva Advogados, in other similar situations of serious illness, in which clinics and hospitals have been disqualified, court decisions have been favorable to patients in order to guarantee that they remain in the same place where they started the treatment.